An ATS policy statement on palliative care for people with serious respiratory illness has reinforced the importance of introducing palliative care early in the care continuum.
Presented at ATS 2022, the long awaited update of a 2008 statement also fleshes out the care delivery models recommending staged levels of primary, secondary and tertiary palliative care.
It sets thresholds for initiating each level of care based on multiple domains of lung function, symptoms, care needs, exacerbations, advanced therapies and caregivers.
One of the coauthors on the policy statement, Associate Professor Natasha Smallwood told the limbic that the 2022 update was a much broader statement than the earlier iteration.
It recognises the growth and advances in the field as well as wider representation in the development of the statement.
“The original statement was really just the ATS but in this statement there are numerous partner associations so there is really that recognition that palliative care in serious respiratory illness is actually the domain of multiple different specialist organisations,” she said.
“It really requires collaborative partnerships to try and deliver this type of care.”
Associate Professor Smallwood, from the Royal Melbourne and Alfred Hospitals, said the new policy statement also included much more about diversity, inclusivity and access to high quality care.
“This policy statement is very specific about saying we really need to recognise that everyone has a right to access this and be more proactive in trying to steer that.”
She said Australia, along with the UK, US and some European countries perform comparatively well globally.
“But there are still huge gaps. Where we really struggle is around equality of access because Australia is geographically vast and culturally diverse as well, so there are some key areas where we need to do more.”
“In regional Australia it is really challenging to access palliative care for people with chronic, non-malignant respiratory conditions.”
Symptom management
The policy statement includes a comprehensive list of clinical tools that can be used to assess different symptoms in different types of respiratory conditions.
“What was not mentioned as much in the previous statement was that it is imperative to measure symptoms because if you cannot measure it, it is very difficult to come up with targeted strategies to address it.”
Associate Professor Smallwood said while the 2008 statement focussed on pain and dyspnoea, the new statement covers a much broader range of symptoms including fatigue and cough and common symptom clusters.
“And while we have shied away from being overly specific — it’s a policy statement not a guideline — we’ve actually been much more holistic in talking about the non-pharmacological approaches as well as the pharmacological approaches to managing symptoms.”
The policy statement notes that advanced palliative therapies such as endobronchial valves in COPD and palliative radiation or stents in lung cancer may be considered in selected patients.